番茄社区

In part 1 of this exclusive video interview, 番茄社区's editor-in-chief Jeremy Faust, MD, talks with Craig Spencer, MD, MPH, of Brown University in Providence, Rhode Island, about the 10-year anniversary of his treatment for Ebola at Bellevue Hospital in New York City.

The following is a transcript of their remarks:

Faust: Hello, Jeremy Faust, medical editor-in-chief of 番茄社区. I'm so excited to be joined today by Dr. Craig Spencer.

Craig Spencer is an emergency physician and associate professor at Brown University and the Brown University School of Public Health. Ten years ago, he was working with Doctors Without Borders treating patients with Ebola in Guinea and returned to the United States and later found out that he had contracted Ebola virus. This month marks the 10-year anniversary of his treatment at Bellevue Hospital and ultimately his discharge, and he has since gone on to do great work.

Dr. Spencer, Craig, thank you so much for being here.

Spencer: Thank you for having me on.

Faust: So how did you find out 10 years ago that you had Ebola?

Spencer: You know, I really found out when my provider sat down next to me on my bed when I was at Bellevue Hospital and said, "Well, your Ebola test is positive." But I kind of knew earlier in the day when I had a fever and had been taking all of my anti-malaria medications religiously the whole time that I was away.

Having been in an environment where I worked every single day with dozens and dozens of patients who had Ebola, sure I was using protection and we knew that that reduced the risk to nearly zero, but not to fully zero. So I had an idea, then I had certainty, then I had a couple weeks of difficulty.

Faust: Yeah. Do you know how you got it and what was the window from the last patient you treated until you had symptoms, until you got diagnosed?

Spencer: Yeah. The last patient I treated was somewhere around maybe October 13th or 14th. I got back to the U.S. on October 16th, and I think went to the hospital October 23rd. I'm sure a quick search of the internet will bring up hundreds of articles determining whether or not that's true. So it was probably around 9 days or so from the last patient contact until I developed a fever.

In terms of where I got sick, almost certainly inside the treatment center where every day I took care of folks for hours and hours, who often at the last moments of their life were having a lot of vomiting, having a lot of diarrhea, were really dehydrated. And I and the team that I worked with were absolutely intent on making sure that if people were going to die, that they were going to die with some dignity. Not covered in their own excrement and their own feces, their own vomit.

That is absolutely the highest risk moment, when taking care of people where there's just virus all around. Even in personal protective equipment, sometimes it can get through.

Faust: Do you have a moment where you thought, "Oh, I made a mistake," or it's just the law of averages, something happened?

Spencer: It's almost impossible to describe what it's like to be in a place like that to folks that have never been in a place like that. But every moment felt like a landmine from the time you got in the country and started taking care of patients. From the first patients you saw, the first time you put in an IV on someone -- something that I do all the time, I've done thousands and thousands of times -- but it was almost as if I was doing it the first time in West Africa, in Guinea, because I was in a really hot suit and it was a really hot day and I was already dehydrated and I was wearing two pairs of gloves, and I was scared, scared, scared. Knowing that if I missed, if something happened, if I poked myself, had a needle stick injury, I would die. It's not that I would be infected. It's not that I would get sick. It's that I would die.

Faust: And by the way, that's just a bravery that you and people like you accept, and I just want to acknowledge that that is awesome and amazing.

When you came back to the United States, you felt fine. You went about your business, you famously went bowling, you got in an Uber, all these things -- and people lost their collective minds because they thought that you were putting people at risk. I know that you don't feel guilty about that because you also know about the dynamics of the spread. This is not a virus that spreads asymptomatically; it's got a long incubation period.

How did you handle that moment? You probably were thinking about your life, but did it affect you that people were saying, "Craig Spencer's not a hero, he is a dangerous person who put us all at risk?"

Spencer: Honestly, no. I don't think anyone that went to do that and the thousands of other people from around the world that really showed up, including the tens of thousands of people in Guinea, Liberia, and Sierra Leone that put themselves and their own family on the line -- those are the real heroes here.

But I don't think anyone that showed up from the U.S., people like myself, went there to be a hero. I think we went there because we heeded a call knowing that if we didn't put this out at its source, we were going to be in really big trouble if this spread further internationally.

At the time that I got sick, there was no TV in the room where I was treated. Apparently they had just that morning checked all the boxes to be completely prepared and ready for an Ebola patient. And maybe the one box that they didn't see -- because it was the least important at the bottom -- was to make sure there was a TV in the room with cable and 2,500 channels or something. There was none of that.

So it was probably good, right? I had an idea of what was happening outside, but that was not at all where my focus was at.

What I knew then -- and what history has proven to be correct over and over again -- is that you don't transmit, you're not infectious until you're symptomatic. And that the public health guidelines that the organization I was working for and that other public health organizations had developed around that time worked. They worked, they worked just as they were supposed to.

And I am not only proud of the fact that they worked, but I will stand up again and again and say it's really important and really valuable to have organizations, public health organizations, that can give us that guidance so we're able to do this and do this correctly. It's really easy to give broad guidance that doesn't accord with the science. That just means that people aren't going to support it, aren't going to follow it, and then we make ourselves a lot less safe.

Faust: And I just want to reiterate for this audience that unlike COVID, where we learned about that virus in real time, this is not the case with Ebola. We understand from experience that what you just said is true. And the example I always hold up is that the gentleman who passed away from Ebola in Texas was discharged from the ER [emergency room] with Ebola unbeknownst to anybody, went home, hung out with his family, they were taking care of him for days with no kind of precautions, and none of them got Ebola. But then when he was readmitted to the hospital and they diagnosed him, all the precautions were in place, and two nurses wearing full PPE [personal protective equipment] did get Ebola.

So it really is truly a disease that is different than say a COVID or an influenza in that it's transmissible at the end. So I just want people to understand that this is not an area where there's known unknowns. We know this thing.

Spencer: Yeah. And it's also important to point out the fact that very much unlike COVID, where there is asymptomatic transmission, we know that virus can linger in spaces, whether it's poor ventilation, for example. You can walk into a room unbeknownst to you and be exposed and be infected, which is why we had a whole host of precautions in place over the past nearly 5 years.

With Ebola -- Ebola is a disease of compassion. It is transmitted by caring. And so it is people like healthcare providers, people that put themselves on the line, many of them often with inadequate or insufficient personal protective equipment but still do this because they feel duty bound to take care of people at the most infectious period of their illness. And also family members, the people that if you can't find a hospital to take care of you, if you can't afford to get treatment at a clinic, you're always going to have your family there to do this, regardless of the risk to them.

And that is where Ebola spread. It's spread through compassion. It's spread through care. That's why really close family members and really heroic local physicians in most scenarios were the ones that were on the line and most likely to be exposed.

Faust: Agreed. And that's why I've written a lot of stuff over the years, but my piece about Kaci Hickox in which I said that we ought to be celebrating people like her and not punishing them with unnecessary precautions, I think that stands and it stands for all of your colleagues. I have so much admiration for you and everyone else in that space.

I do want to talk about the moments after that diagnosis. And you know, Craig, you and I are very good friends, but we haven't talked about this part. I've heard you talk a little bit about the ICU [intensive care unit] at Bellevue Hospital, but can you just take us through literally the moment? OK, you have Ebola -- or at least your test was positive, which is the you have Ebola moment -- literally what happens next? Like, here, put on this mask, put on this space suit. What is your doctor wearing at that point? And tell me just the next 5 minutes, the next 10 minutes, what happens in those moments?

Spencer: So all interaction that I had had once I had arrived in Bellevue, in the treatment room itself, was with providers wearing personal protective equipment.

Faust: What did that look like? Can you tell us specifically what they were?

Spencer: Space suits. I mean, it looked like Buzz Aldrin landing on the moon. But the PAPRs [powered air purifying respirators], this type of personal protective equipment, is way more comfortable for them. It's meant to be much more protective, much easier to put on and take off, and to lower the risk of infection for providers, which is key and very important.

So yes, we're having all conversations -- for me, the next 19 days every conversation was with someone, usually a nurse in my room, in one of those spacesuits. But in the first couple minutes after my confirmed diagnosis, the question was like, OK, what do we do next?

And what I appreciated was having a medical team that knew that when it came to treating Ebola patients, compared to them I was the expert. Right? This is something that I had done hundreds of times in the past month before.

And so we were able to chat about things that I saw, things that I worried about, things that we should be thinking about, and they were able to be there, be present, listen, but also kind of strategize the next steps. "OK, let's think about some of the investigational medications that maybe we could look into. Let's think about how we're going to handle this, this, this, or this. What should we do with your family? How do we think about this from a media perspective? Do we hold on announcing this? Do we wait?" And so it was a lot of those conversations, more logistics and kind of nuts and bolts of what comes next.

I don't particularly remember thinking, "Oh my gosh, this is my death sentence." I do remember thinking then -- and more so over the next couple days -- of how incredibly lucky, in almost a guilty sense, that I was able to come into Bellevue in the afternoon and by that evening already have a positive test, know that my test was positive.

Because for the past 6 weeks, I had taken care of patients, many of whom waited days, if not longer, to get their test results back. And that whole time being in limbo, not knowing what's happening, being inside an Ebola treatment center, and maybe you have just malaria, or maybe you have malaria and Ebola but you don't know. And then maybe you finally get that diagnosis days later. I had it within hours and I was grateful for that, but also felt a bit guilty that I had access to something that the hundreds of people I had just seen and taken care of didn't.

Faust: Yeah. And we'll come back to that. That's an area where you've spoken eloquently [about] many times, and I want to reiterate that too.

The special pathogens team at Bellevue did wonderful work. I think they were as prepared as anybody could be. But I still don't even know where you went. Were you in the ER when you came in, or were they like, "Oh wait, you're a PUI" -- person under investigation -- or "You're a high-likelihood Ebola patient, you're going right to the ICU"? Where were you literally and what were you wearing? Did they put you in any kind of protective equipment?

Spencer: That's a good question. I don't think they dressed me up, which is probably good. I think I was focused on some other things. But you know, I went straight from the ambulance up to a treatment room, a dedicated treatment room, so there wasn't an intermediary stop. It was directly from ambulance to treatment room -- negative pressure where you put a PUI, a person or a patient under investigation. So yeah, a direct line from one to the other.

Faust: Is that the ICU in that case?

Spencer: That was a room that had been kind of retrofitted. It was previously where tuberculosis patients that needed a longer stay for treatment in the hospital would stay. So that area of that floor had been repurposed as the special pathogen unit where they would take care of Ebola patients and anyone else with concerning, high-consequence diseases.

Faust: Is that the room where you stayed for the next several, I guess, couple of weeks?

Spencer: It was indeed. I went in and had a 19-day stay in the exact same spot. Maybe, I don't know, 90 square feet, which in New York is pretty spacious, but after nearly 3 weeks it starts to feel a little small.

Faust: Yeah. I was wondering, because again, with all the protocols in place we ought to believe that it's a very containable pathogen, and yet if I'm in the ICU and the guy in the next booth has Ebola, I might be a little concerned. This is not the case.

Spencer: Absolutely not. No, no, no, 100%.

The people at greatest risk really were me -- my risk of dying just looking at the numbers was a coin flip -- but the next greatest risk of course was the nurses, primarily the nurses. There were many of those every single day that came into my room to help with all manner of things, and they were at the highest risk of exposure, them and the other healthcare providers. But in terms of nosocomial transmission, transmission around the hospital, the risk of that was zilch.

Faust: Right. And again, hats off to the Bellevue team. One of the big things that we as doctors don't think about are some other risks, like waste management. What happens to the stuff coming out of your body, the toilet? And they have to deal with that. That's a really big challenge, and they did a remarkable job.

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